Anti-Neuronal Antibody Screening
for Paraneoplastic Neurological Syndromes

Contact Information

 Address: Laboratory Special Services
Davis Wing, Room 2296
University of Virginia Health System
Charlottesville, VA 22908
 Telephone:  (540) 924-2430
 E-Mail:  pmk@virginia.edu Paula Keeney

Anti-neuronal antibodies are used to aid in the diagnosis of paraneoplastic neurological syndromes (remote, nonmetastatic complications of systemic cancer).

Anti-neuronal antibodies are detected in the serum and CSF of the majority of patients with typical paraneoplastic neurological syndromes and are not present in normal individuals. The antibody pattern is indicative of the tumor type as indicated below:

Type I staining
(also called anti-Yo or anti-Purkinje cell antibody) is seen in paraneoplastic cerebellar degeneration and is strongly suggestive of underlying ovarian, breast or gynecological cancer. This syndrome is characterized clinically by subacute progressive ataxia, nystagmus and dysarthria.
Type IIa staining
(anti-Hu, ANNA-1) occurs in paraneoplastic sensory neuronopathy and encephalomyelitis and is highly associated with small cell lung cancer.
Type IIb staining
(anti-Ri, ANNA-2) is seen in paraneoplastic opsoclonus/ ataxia and is usually associated with breast cancer and occasionally with small cell lung cancer.
Anti-neuronal antibody screening is an indirect immunofluorescent assay in which sections of normal human cerebellum are used as the substrate. Positive results are confirmed by western blot. Results are sent out in the form of a consult from the physician interpreting the assay.

With prior notification, a similar two-step process can be carried out against retinal tissue to assay for the anti-retinal antibodies in paraneoplastic retinal degeneration (the subacute, painless visual loss associated with small cell lung cancer and breast cancer).

NOTE: Anti-neuronal screening will also detect the anti-GAD antibodies seen in many cases of stiff-man syndrome.

Preparing the Specimens
The assay is usually performed on serum. CSF will be assayed free of charge if it is included with a serum sample. No special patient preparations are needed. The minimum volume is 0.5 ml; 1.0 ml is preferred. Store specimens (CSF or separated serum) at 4 degrees C until shipment. If shipping is delayed for more than one week, store at -20 degrees C. Hemolysis and lipemia have no effect on this test.

Shipping the Specimens
Please include the patient's name, clinical diagnosis, and billing information, and the name, address and phone number of the referring physician with the specimen. A brief clinical history would be appreciated. It is recommended that samples be shipped at ambient temperature by next-day service to the above address.